| NPI | 1972132025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 33799) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 57097) |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2024-08-30 |